Discussions By Condition: I cannot get a diagnosis.

Pudendal nerve entrapment or something else???

Hi everyone,I would like to ask if anyone has suffered or has knowledge about abdominal nerve entrapment. Last year I had a laparoscopy and since then I have been feeling a constant pain. I had numerous ultrasounds, scans, blood tests, urine tests.Docs thought I might even have Chron disase as the pain is on the right hand side lower abdominal pain, at the groin area. I had colonoscopy, and my small intestines were filled up with X ray liquid as well. Gastro doc said that the last 10 cms of small intestines were a bit inflammed but it is not Chron (no diarrhoea,no weight decrease) So they sent me to gyna doc, several usounds but nothing. Finally an other laparosocopy,nothing significant or better to say they found an endomtetriosis lump and removed it. But not from the painful area but from somewhere left side. I was shocked as it never hurt and my original problem wasnt solved. So other 2 months in turmoil... I cannot even work as the pain is so bad but as they dont know the origin they think Im making it up. Finally this May my appendix was removed. The surgeon said that it indicated several inflammation so she thought it is better to remove it. After the op I have been not well, I have the original problem and now Im really depressed. The doc said that maybe they hurt a nerve last year and that is causing the problem. I cannot believe it. The pain is always at present.To be honest first I thought they something inside in the op as I feel as if a needle prickling me. I developed a special way to sit as when I put all my weight evenly it hurts so I tilt a bit to the left instead. When I move around the pain is even worse. I feel that even my abdominal wall is sensitive and always warm. When Im travelling in a car or ride a bike and there is a bump on the road then I feel something inside my tummy hurts terrible at the movement. Sorry for being so long but it has been going on for more than a year, destroying my life completely.:(

4 Replies:

Okay, please provide some clarification. Why did you have the original laparoscopy? Typically, pudendal nerve entrapment causes pain that either directly affects the genitalia or very proximal within the perineum. Depending upon your geographic location, there are several places where you can obtain an MR neurography to determine whether the pudendal nerve is responsible for the pain. Again, it depends more precisely where your pain is located and the relevant medical history associated with your symptoms. Best regards, J Cottle, MD

Thank you for your reply.The pain is on the right hand side just around the area where the laparoscopy device entered above the pubic area. It is emitting sometimes down to my genitals as well. RIghtly after the operation last April I noticed that whenever I took a shower the touch of the skin was strangely numb and it has been since then. The pain is relatively bearable when I lie down but whenever Im up and move around it is very bad. The surgeon who operated me on last time said that I had chronic appendicitis and they removed it a month ago. I went back several times to the hospital afterwards telling him that I still feel that 'strangling' pain in my stomach, and the increasing pain whenever Im travelling in a car. (bumpy road) I simply dont know what is still wrong. I would like to ask if I can have an MR scan after they applied metal clips during the appendix removal?

Sorry I forgot that I had the original pain as I had pain on the left hand side and they didnt know why. My gyna doc thought maybe endometriosis but it didnt prove then. Im not sure if I said that there were complications during the op, the abdominal wall started to bleed severely (where now I have the pain)The doc who operated me now said that maybe my appendix was doing the trouble even a year ago but somehow they missed it.:confused:

Okay, I believe you stated in your response that the original laparoscopy was to the left lower quadrant and exploratory in nature because they could not locate the source of the pain. Firstly, the pain from chronic appendicitis would settle into the lower right quadrant, not the left, and the symptoms of chronic appendicitis are the same as the acute form only much milder over and extended period. It's important to note that unless you were suffering symptoms of fever, nausea, RLQ pain and fatigue, then it's highly unlikely that your appendix was responsible to any extent whatsoever. Secondly, laparoscopy is absolutely contraindicated as a means to conduct mere exploratory surgery. Your doctors would have needed some clinical basis for doing so and being that this is the 21st century, we just don't go inside people looking around for the source of problems. There's other information here that needs to be brought to light that's contained in your medical records. The insufflation gas used to provide internal separation and support of tissues for optimal viewing with the scope has been the subject of discussion where certain post-laparoscopic pain syndrome is described by patients. But again, I'm frankly puzzled by the lack of specific information related to why they performed the laparoscopy. You need to obtain complete copies of your medical records where the surgery was concerned for further clarification of both the need for the procedure and the complications which arose. Based upon your description, it' s only speculative at this point whether the pudendal nerve is involved in your case but you need to be evaluated through MR neurography by a source OTHER than the healthcare center where the surgery was performed. A fellow by the name of Aaron Filler in California is a surgeon pretty much on the cutting edge of pain associated with the pudendal nerve and it may be worth your time to contact him to discuss your case and determine whether direct evaluation by him would be beneficial. Please be aware, however, that you'll need to provide far more information than you're listing on this forum and if requested, you'll need to have copies of all related medical records forwarded to his office. Your pain syndrome is not something you would simply have to live with in this instance. Best regards, J Cottle, MD